Aortic Root Replacement for Destructive Aortic Valve Endocarditis or Aortitis / 日本心臓血管外科学会雑誌

Destructive aortic valve endocarditis or poor controlled aortitis cause the development of left ventricular-aortic discontinuity. We reported our experience with aortic root replacement for cases of severe aortic annular destruction. Between 1999 and 2006, 9 patients with severe aortic annular destruction underwent aortic root replacement at our institute. There were 8 men and one women with a mean age of 55 years. Seven patients were in New York Heart Association functional class III. Four of 9 patients had native valve endocarditis, 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2, aortic root replacements in 2) and one had active aortitis with a detached mechanical valve. Radical debridement of the infected cavity and necrotic tissue was performed in all cases, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 3 cases. Antibiotic-saturated fibrin glue was applied to the cavity. Aortic root replacement was achieved with a pulmonary autograft (Ross procedure) in 4 and stentless aortic root xenograft in 4. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary implantation method. No mortality was observed during hospitalization and follow-up. Reoperation within 5 years was not necessary in 66.7% of the patients. Excellent outcome can be achieved by radical exclusion of the abscess cavity and viable pulmonary autograft or stentless aortic root xenograft in patients with severe aortic annular destruction.

Cardiac Operations in Two Patients Aged 90 or Over / 日本心臓血管外科学会雑誌

Cardiac surgery in patients aged 90 years or older is not common. We report 2 successful cases in nonagenarians. A 90-year-old man underwent the Bentall operation for aortic root aneurysm with moderate aortic valve regurgitation. A 91-year-old man underwent aortic valve replacement and single CABG (LITA to LCX) for severe aortic valve stenosis with single coronary artery disease. Their postoperative courses were uneventful. We emphasize that cardiac surgery in nonagenarians should not be withheld on the basis of age alone, but should be based on careful assessments of the relative medical risks and benefits, as well as the wishes of the patient and family.